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J Thorac Cardiovasc Surg 1994;108:719-726
© 1994 Mosby, Inc.

SURGERY FOR ACQUIRED HEART DISEASE

New surgical method of chordal replacement for mitral valve incompetence with echocardiographic guidanceAn experimental study

Takatsugu Shimono, MD, Hiroshi Yuasa, MD, Toru Mizumoto, MD, Katsumoto Hatanaka, MD, Hitoshi Kusagawa, MD, Isao Yada, MD


Tsu, Japan

From the Department of Thoracic and Cardiovascular Surgery, Mie University, School of Medicine, Tsu, Japan.

Received for publication Jan. 28, 1994. Accepted for publication May 10, 1994. Address for reprints: Takatsugu Shimono, MD, Department of Surgery, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030.

Abstract

Chordal replacement with expanded polytetrafluoroethylene suture has become a procedure of choice for repairing anterior leaflet prolapse among certain surgeons. However, most surgeons believe that the chordal replacement is too complicated and not reproducible. This report introduces a new method of chordal replacement using intraoperative epicardial and transesophageal echocardiography. Three dogs underwent the following procedures. One major marginal chorda of an anterior mitral leaflet was resected during cardiopulmonary bypass. A specially designed 3-0 polytetrafluoroethylene suture, having straight needles, was attached to the anterior leaflet by a mattress suture. Then the needles were brought from the root of the anterior papillary muscle to the outside of the left ventricle. After the bypass flow was reduced, both ends of the polytetrafluoroethylene suture were pulled under echocardiographic guidance until valve competence was achieved. At that point, the suture was temporarily tied. When cardiopulmonary bypass was discontinued, competence was again confirmed and the suture was tied permanently. When the procedures were completed, echocardiography showed trivial regurgitation and good pliability of the anterior leaflets in all animals. Left atrial pressures were sufficiently decreased. It appears that this new technique is reproducible for all surgeons because the optimal length of polytetrafluoroethylene chordae is determined with the valve functioning. (J THORAC CARDIOVASC SURG 1994;108:719-26)






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Copyright © 1994 by The American Association for Thoracic Surgery.